TY - JOUR T1 - The Global Burden of Cancer 2013. JF - JAMA Oncol Y1 - 2015 A1 - Fitzmaurice, Christina A1 - Dicker, Daniel A1 - Pain, Amanda A1 - Hamavid, Hannah A1 - Moradi-Lakeh, Maziar A1 - MacIntyre, Michael F A1 - Allen, Christine A1 - Hansen, Gillian A1 - Woodbrook, Rachel A1 - Wolfe, Charles A1 - Hamadeh, Randah R A1 - Moore, Ami A1 - Werdecker, Andrea A1 - Gessner, Bradford D A1 - Te Ao, Braden A1 - McMahon, Brian A1 - Karimkhani, Chante A1 - Yu, Chuanhua A1 - Cooke, Graham S A1 - Schwebel, David C A1 - Carpenter, David O A1 - Pereira, David M A1 - Nash, Denis A1 - Kazi, Dhruv S A1 - De Leo, Diego A1 - Plass, Dietrich A1 - Ukwaja, Kingsley N A1 - Thurston, George D A1 - Yun Jin, Kim A1 - Simard, Edgar P A1 - Mills, Edward A1 - Park, Eun-Kee A1 - Catalá-López, Ferrán A1 - deVeber, Gabrielle A1 - Gotay, Carolyn A1 - Khan, Gulfaraz A1 - Hosgood, H Dean A1 - Santos, Itamar S A1 - Leasher, Janet L A1 - Singh, Jasvinder A1 - Leigh, James A1 - Jonas, Jost A1 - Sanabria, Juan A1 - Beardsley, Justin A1 - Jacobsen, Kathryn H A1 - Takahashi, Ken A1 - Franklin, Richard C A1 - Ronfani, Luca A1 - Montico, Marcella A1 - Naldi, Luigi A1 - Tonelli, Marcello A1 - Geleijnse, Johanna A1 - Petzold, Max A1 - Shrime, Mark G A1 - Younis, Mustafa A1 - Yonemoto, Naohiro A1 - Breitborde, Nicholas A1 - Yip, Paul A1 - Pourmalek, Farshad A1 - Lotufo, Paulo A A1 - Esteghamati, Alireza A1 - Hankey, Graeme J A1 - Ali, Raghib A1 - Lunevicius, Raimundas A1 - Malekzadeh, Reza A1 - Dellavalle, Robert A1 - Weintraub, Robert A1 - Lucas, Robyn A1 - Hay, Roderick A1 - Rojas-Rueda, David A1 - Westerman, Ronny A1 - Sepanlou, Sadaf G A1 - Nolte, Sandra A1 - Patten, Scott A1 - Weichenthal, Scott A1 - Abera, Semaw Ferede A1 - Fereshtehnejad, Seyed-Mohammad A1 - Shiue, Ivy A1 - Driscoll, Tim A1 - Vasankari, Tommi A1 - Alsharif, Ubai A1 - Rahimi-Movaghar, Vafa A1 - Vlassov, Vasiliy V A1 - Marcenes, W S A1 - Mekonnen, Wubegzier A1 - Melaku, Yohannes Adama A1 - Yano, Yuichiro A1 - Artaman, Al A1 - Campos, Ismael A1 - MacLachlan, Jennifer A1 - Mueller, Ulrich A1 - Kim, Daniel A1 - Trillini, Matias A1 - Eshrati, Babak A1 - Williams, Hywel C A1 - Shibuya, Kenji A1 - Dandona, Rakhi A1 - Murthy, Kinnari A1 - Cowie, Benjamin A1 - Amare, Azmeraw T A1 - Antonio, Carl Abelardo A1 - Castañeda-Orjuela, Carlos A1 - van Gool, Coen H A1 - Violante, Francesco A1 - Oh, In-Hwan A1 - Deribe, Kedede A1 - Soreide, Kjetil A1 - Knibbs, Luke A1 - Kereselidze, Maia A1 - Green, Mark A1 - Cárdenas, Rosario A1 - Roy, Nobhojit A1 - Tillman, Taavi A1 - Li, Yongmei A1 - Krueger, Hans A1 - Monasta, Lorenzo A1 - Dey, Subhojit A1 - Sheikhbahaei, Sara A1 - Hafezi-Nejad, Nima A1 - Kumar, G Anil A1 - Sreeramareddy, Chandrashekhar T A1 - Dandona, Lalit A1 - Wang, Haidong A1 - Vollset, Stein Emil A1 - Mokdad, Ali A1 - Salomon, Joshua A A1 - Lozano, Rafael A1 - Vos, Theo A1 - Forouzanfar, Mohammad A1 - Lopez, Alan A1 - Murray, Christopher A1 - Naghavi, Mohsen AB -

IMPORTANCE: Cancer is among the leading causes of death worldwide. Current estimates of cancer burden in individual countries and regions are necessary to inform local cancer control strategies.

OBJECTIVE: To estimate mortality, incidence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 28 cancers in 188 countries by sex from 1990 to 2013.

EVIDENCE REVIEW: The general methodology of the Global Burden of Disease (GBD) 2013 study was used. Cancer registries were the source for cancer incidence data as well as mortality incidence (MI) ratios. Sources for cause of death data include vital registration system data, verbal autopsy studies, and other sources. The MI ratios were used to transform incidence data to mortality estimates and cause of death estimates to incidence estimates. Cancer prevalence was estimated using MI ratios as surrogates for survival data; YLDs were calculated by multiplying prevalence estimates with disability weights, which were derived from population-based surveys; YLLs were computed by multiplying the number of estimated cancer deaths at each age with a reference life expectancy; and DALYs were calculated as the sum of YLDs and YLLs.

FINDINGS: In 2013 there were 14.9 million incident cancer cases, 8.2 million deaths, and 196.3 million DALYs. Prostate cancer was the leading cause for cancer incidence (1.4 million) for men and breast cancer for women (1.8 million). Tracheal, bronchus, and lung (TBL) cancer was the leading cause for cancer death in men and women, with 1.6 million deaths. For men, TBL cancer was the leading cause of DALYs (24.9 million). For women, breast cancer was the leading cause of DALYs (13.1 million). Age-standardized incidence rates (ASIRs) per 100 000 and age-standardized death rates (ASDRs) per 100 000 for both sexes in 2013 were higher in developing vs developed countries for stomach cancer (ASIR, 17 vs 14; ASDR, 15 vs 11), liver cancer (ASIR, 15 vs 7; ASDR, 16 vs 7), esophageal cancer (ASIR, 9 vs 4; ASDR, 9 vs 4), cervical cancer (ASIR, 8 vs 5; ASDR, 4 vs 2), lip and oral cavity cancer (ASIR, 7 vs 6; ASDR, 2 vs 2), and nasopharyngeal cancer (ASIR, 1.5 vs 0.4; ASDR, 1.2 vs 0.3). Between 1990 and 2013, ASIRs for all cancers combined (except nonmelanoma skin cancer and Kaposi sarcoma) increased by more than 10% in 113 countries and decreased by more than 10% in 12 of 188 countries.

CONCLUSIONS AND RELEVANCE: Cancer poses a major threat to public health worldwide, and incidence rates have increased in most countries since 1990. The trend is a particular threat to developing nations with health systems that are ill-equipped to deal with complex and expensive cancer treatments. The annual update on the Global Burden of Cancer will provide all stakeholders with timely estimates to guide policy efforts in cancer prevention, screening, treatment, and palliation.

VL - 1 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26181261?dopt=Abstract ER - TY - JOUR T1 - Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. 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Tillmann, Taavi A1 - Tobollik, Myriam A1 - Tonelli, Marcello A1 - Topouzis, Fotis A1 - Towbin, Jeffrey A A1 - Toyoshima, Hideaki A1 - Traebert, Jefferson A1 - Tran, Bach X A1 - Trasande, Leonardo A1 - Trillini, Matias A1 - Trujillo, Ulises A1 - Dimbuene, Zacharie Tsala A1 - Tsilimbaris, Miltiadis A1 - Tuzcu, Emin Murat A1 - Uchendu, Uche S A1 - Ukwaja, Kingsley N A1 - Uzun, Selen B A1 - van de Vijver, Steven A1 - Van Dingenen, Rita A1 - van Gool, Coen H A1 - van Os, Jim A1 - Varakin, Yuri Y A1 - Vasankari, Tommi J A1 - Vasconcelos, Ana Maria N A1 - Vavilala, Monica S A1 - Veerman, Lennert J A1 - Velasquez-Melendez, Gustavo A1 - Venketasubramanian, N A1 - Vijayakumar, Lakshmi A1 - Villalpando, Salvador A1 - Violante, Francesco S A1 - Vlassov, Vasiliy Victorovich A1 - Vollset, Stein Emil A1 - Wagner, Gregory R A1 - Waller, Stephen G A1 - Wallin, Mitchell T A1 - Wan, Xia A1 - Wang, Haidong A1 - Wang, JianLi A1 - Wang, Linhong A1 - Wang, Wenzhi A1 - Wang, Yanping A1 - Warouw, Tati S A1 - Watts, Charlotte H A1 - Weichenthal, Scott A1 - Weiderpass, Elisabete A1 - Weintraub, Robert G A1 - Werdecker, Andrea A1 - Wessells, K Ryan A1 - Westerman, Ronny A1 - Whiteford, Harvey A A1 - Wilkinson, James D A1 - Williams, Hywel C A1 - Williams, Thomas N A1 - Woldeyohannes, Solomon M A1 - Wolfe, Charles D A A1 - Wong, John Q A1 - Woolf, Anthony D A1 - Wright, Jonathan L A1 - Wurtz, Brittany A1 - Xu, Gelin A1 - Yan, Lijing L A1 - Yang, Gonghuan A1 - Yano, Yuichiro A1 - Ye, Pengpeng A1 - Yenesew, Muluken A1 - Yentür, Gökalp K A1 - Yip, Paul A1 - Yonemoto, Naohiro A1 - Yoon, Seok-Jun A1 - Younis, Mustafa Z A1 - Younoussi, Zourkaleini A1 - Yu, Chuanhua A1 - Zaki, Maysaa E A1 - Zhao, Yong A1 - Zheng, Yingfeng A1 - Zhou, Maigeng A1 - Zhu, Jun A1 - Zhu, Shankuan A1 - Zou, Xiaonong A1 - Zunt, Joseph R A1 - Lopez, Alan D A1 - Vos, Theo A1 - Murray, Christopher J AB -

BACKGROUND: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.

METHODS: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol.

FINDINGS: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa.

INTERPRETATION: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

FUNDING: Bill & Melinda Gates Foundation.

VL - 386 IS - 10010 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26364544?dopt=Abstract ER - TY - JOUR T1 - Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition. JF - Lancet Y1 - 2015 A1 - Murray, Christopher J L A1 - Barber, Ryan M A1 - Foreman, Kyle J A1 - Abbasoglu Ozgoren, Ayse A1 - Abd-Allah, Foad A1 - Abera, Semaw F A1 - Aboyans, Victor A1 - Abraham, Jerry P A1 - Abubakar, Ibrahim A1 - Abu-Raddad, Laith J A1 - Abu-Rmeileh, Niveen M A1 - Achoki, Tom A1 - Ackerman, Ilana N A1 - Ademi, Zanfina A1 - Adou, Arsène K A1 - Adsuar, José C A1 - Afshin, Ashkan A1 - Agardh, Emilie E A1 - Alam, Sayed Saidul A1 - Alasfoor, Deena A1 - Albittar, Mohammed I A1 - Alegretti, Miguel A A1 - Alemu, Zewdie A A1 - Alfonso-Cristancho, Rafael A1 - Alhabib, Samia A1 - Ali, Raghib A1 - Alla, François A1 - Allebeck, Peter A1 - AlMazroa, Mohammad A A1 - Alsharif, Ubai A1 - Alvarez, Elena A1 - Alvis-Guzmán, Nelson A1 - Amare, Azmeraw T A1 - Ameh, Emmanuel A A1 - Amini, Heresh A1 - Ammar, Walid A1 - Anderson, H Ross A1 - Anderson, Benjamin O A1 - Antonio, Carl Abelardo T A1 - Anwari, Palwasha A1 - Arnlöv, Johan A1 - Arsic Arsenijevic, Valentina S A1 - Artaman, Al A1 - Asghar, Rana J A1 - 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Toyoshima, Hideaki A1 - Traebert, Jefferson A1 - Tran, Bach X A1 - Trillini, Matias A1 - Truelsen, Thomas A1 - Tsilimbaris, Miltiadis A1 - Tuzcu, Emin M A1 - Uchendu, Uche S A1 - Ukwaja, Kingsley N A1 - Undurraga, Eduardo A A1 - Uzun, Selen B A1 - Van Brakel, Wim H A1 - van de Vijver, Steven A1 - van Gool, Coen H A1 - van Os, Jim A1 - Vasankari, Tommi J A1 - Venketasubramanian, N A1 - Violante, Francesco S A1 - Vlassov, Vasiliy V A1 - Vollset, Stein Emil A1 - Wagner, Gregory R A1 - Wagner, Joseph A1 - Waller, Stephen G A1 - Wan, Xia A1 - Wang, Haidong A1 - Wang, JianLi A1 - Wang, Linhong A1 - Warouw, Tati S A1 - Weichenthal, Scott A1 - Weiderpass, Elisabete A1 - Weintraub, Robert G A1 - Wenzhi, Wang A1 - Werdecker, Andrea A1 - Westerman, Ronny A1 - Whiteford, Harvey A A1 - Wilkinson, James D A1 - Williams, Thomas N A1 - Wolfe, Charles D A1 - Wolock, Timothy M A1 - Woolf, Anthony D A1 - Wulf, Sarah A1 - Wurtz, Brittany A1 - Xu, Gelin A1 - Yan, Lijing L A1 - Yano, Yuichiro A1 - Ye, Pengpeng A1 - Yentür, Gökalp K A1 - Yip, Paul A1 - Yonemoto, Naohiro A1 - Yoon, Seok-Jun A1 - Younis, Mustafa Z A1 - Yu, Chuanhua A1 - Zaki, Maysaa E A1 - Zhao, Yong A1 - Zheng, Yingfeng A1 - Zonies, David A1 - Zou, Xiaonong A1 - Salomon, Joshua A A1 - Lopez, Alan D A1 - Vos, Theo KW - Aged KW - Chronic Disease KW - Communicable Diseases KW - Female KW - Global Health KW - Health Transition KW - Humans KW - Life Expectancy KW - Male KW - Middle Aged KW - Mortality, Premature KW - Quality-Adjusted Life Years KW - Socioeconomic Factors KW - Wounds and Injuries AB -

BACKGROUND: The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development.

METHODS: We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time.

FINDINGS: Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries.

INTERPRETATION: Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition--in which increasing sociodemographic status brings structured change in disease burden--is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions.

FUNDING: Bill & Melinda Gates Foundation.

VL - 386 IS - 10009 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26321261?dopt=Abstract ER - TY - JOUR T1 - Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. JF - Lancet Y1 - 2014 A1 - Murray, Christopher J L A1 - Ortblad, Katrina F A1 - Guinovart, Caterina A1 - Lim, Stephen S A1 - Wolock, Timothy M A1 - Roberts, D Allen A1 - Dansereau, Emily A A1 - Graetz, Nicholas A1 - Barber, Ryan M A1 - Brown, Jonathan C A1 - Wang, Haidong A1 - Duber, Herbert C A1 - Naghavi, Mohsen A1 - Dicker, Daniel A1 - Dandona, Lalit A1 - Salomon, Joshua A A1 - Heuton, Kyle R A1 - Foreman, Kyle A1 - Phillips, David E A1 - Fleming, Thomas D A1 - Flaxman, Abraham D A1 - Phillips, Bryan K A1 - Johnson, Elizabeth K A1 - Coggeshall, Megan S A1 - Abd-Allah, Foad A1 - Abera, Semaw Ferede A1 - Abraham, Jerry P A1 - Abubakar, Ibrahim A1 - Abu-Raddad, Laith J A1 - Abu-Rmeileh, Niveen Me A1 - Achoki, Tom A1 - Adeyemo, Austine Olufemi A1 - Adou, Arsène Kouablan A1 - Adsuar, José C A1 - Agardh, Emilie Elisabet A1 - Akena, Dickens A1 - Al Kahbouri, Mazin J A1 - Alasfoor, Deena A1 - Albittar, Mohammed I A1 - Alcalá-Cerra, Gabriel A1 - Alegretti, Miguel Angel A1 - Alemu, Zewdie Aderaw A1 - Alfonso-Cristancho, Rafael A1 - Alhabib, Samia A1 - Ali, Raghib A1 - Alla, François A1 - Allen, Peter J A1 - Alsharif, Ubai A1 - Alvarez, Elena A1 - Alvis-Guzmán, Nelson A1 - Amankwaa, Adansi A A1 - Amare, Azmeraw T A1 - Amini, Hassan A1 - Ammar, Walid A1 - Anderson, Benjamin O A1 - Antonio, Carl Abelardo T A1 - Anwari, Palwasha A1 - Arnlöv, Johan A1 - Arsenijevic, Valentina S Arsic A1 - Artaman, Ali A1 - Asghar, Rana J A1 - Assadi, Reza A1 - Atkins, Lydia S A1 - Badawi, Alaa A1 - Balakrishnan, Kalpana A1 - Banerjee, Amitava A1 - Basu, Sanjay A1 - Beardsley, Justin A1 - Bekele, Tolesa A1 - Bell, Michelle L A1 - Bernabe, Eduardo A1 - Beyene, Tariku Jibat A1 - Bhala, Neeraj A1 - Bhalla, Ashish A1 - Bhutta, Zulfiqar A A1 - Abdulhak, Aref Bin A1 - Binagwaho, Agnes A1 - Blore, Jed D A1 - Basara, Berrak Bora A1 - Bose, Dipan A1 - Brainin, Michael A1 - Breitborde, Nicholas A1 - Castañeda-Orjuela, Carlos A A1 - Catalá-López, Ferrán A1 - Chadha, Vineet K A1 - Chang, Jung-Chen A1 - Chiang, Peggy Pei-Chia A1 - Chuang, Ting-Wu A1 - Colomar, Mercedes A1 - Cooper, Leslie Trumbull A1 - Cooper, Cyrus A1 - Courville, Karen J A1 - Cowie, Benjamin C A1 - Criqui, Michael H A1 - Dandona, Rakhi A1 - Dayama, Anand A1 - De Leo, Diego A1 - Degenhardt, Louisa A1 - del Pozo-Cruz, Borja A1 - Deribe, Kebede A1 - Des Jarlais, Don C A1 - Dessalegn, Muluken A1 - Dharmaratne, Samath D A1 - Dilmen, Uğur A1 - Ding, Eric L A1 - Driscoll, Tim R A1 - Durrani, Adnan M A1 - Ellenbogen, Richard G A1 - Ermakov, Sergey Petrovich A1 - Esteghamati, Alireza A1 - Faraon, Emerito Jose A A1 - Farzadfar, Farshad A1 - Fereshtehnejad, Seyed-Mohammad A1 - Fijabi, Daniel Obadare A1 - Forouzanfar, Mohammad H A1 - Fra Paleo, Urbano A1 - Gaffikin, Lynne A1 - Gamkrelidze, Amiran A1 - Gankpé, Fortuné Gbètoho A1 - Geleijnse, Johanna M A1 - Gessner, Bradford D A1 - Gibney, Katherine B A1 - Ginawi, Ibrahim Abdelmageem Mohamed A1 - Glaser, Elizabeth L A1 - Gona, Philimon A1 - Goto, Atsushi A1 - Gouda, Hebe N A1 - Gugnani, Harish Chander A1 - Gupta, Rajeev A1 - Gupta, Rahul A1 - Hafezi-Nejad, Nima A1 - Hamadeh, Randah Ribhi A1 - Hammami, Mouhanad A1 - Hankey, Graeme J A1 - Harb, Hilda L A1 - Haro, Josep Maria A1 - Havmoeller, Rasmus A1 - Hay, Simon I A1 - Hedayati, Mohammad T A1 - Pi, Ileana B Heredia A1 - Hoek, Hans W A1 - Hornberger, John C A1 - Hosgood, H Dean A1 - Hotez, Peter J A1 - Hoy, Damian G A1 - Huang, John J A1 - Iburg, Kim M A1 - Idrisov, Bulat T A1 - Innos, Kaire A1 - Jacobsen, Kathryn H A1 - Jeemon, Panniyammakal A1 - Jensen, Paul N A1 - Jha, Vivekanand A1 - Jiang, Guohong A1 - Jonas, Jost B A1 - Juel, Knud A1 - Kan, Haidong A1 - Kankindi, Ida A1 - Karam, Nadim E A1 - Karch, André A1 - Karema, Corine Kakizi A1 - Kaul, Anil A1 - Kawakami, Norito A1 - Kazi, Dhruv S A1 - Kemp, Andrew H A1 - Kengne, Andre Pascal A1 - Keren, Andre A1 - Kereselidze, Maia A1 - Khader, Yousef Saleh A1 - Khalifa, Shams Eldin Ali Hassan A1 - Khan, Ejaz Ahmed A1 - Khang, Young-Ho A1 - Khonelidze, Irma A1 - Kinfu, Yohannes A1 - Kinge, Jonas M A1 - Knibbs, Luke A1 - Kokubo, Yoshihiro A1 - Kosen, S A1 - Defo, Barthelemy Kuate A1 - Kulkarni, Veena S A1 - Kulkarni, Chanda A1 - Kumar, Kaushalendra A1 - Kumar, Ravi B A1 - Kumar, G Anil A1 - Kwan, Gene F A1 - Lai, Taavi A1 - Balaji, Arjun Lakshmana A1 - Lam, Hilton A1 - Lan, Qing A1 - Lansingh, Van C A1 - Larson, Heidi J A1 - Larsson, Anders A1 - Lee, Jong-Tae A1 - Leigh, James A1 - Leinsalu, Mall A1 - Leung, Ricky A1 - Li, Yichong A1 - Li, Yongmei A1 - de Lima, Graça Maria Ferreira A1 - Lin, Hsien-Ho A1 - Lipshultz, Steven E A1 - Liu, Shiwei A1 - Liu, Yang A1 - Lloyd, Belinda K A1 - Lotufo, Paulo A A1 - Machado, Vasco Manuel Pedro A1 - Maclachlan, Jennifer H A1 - Magis-Rodriguez, Carlos A1 - Majdan, Marek A1 - Mapoma, Christopher Chabila A1 - Marcenes, Wagner A1 - Marzan, Melvin Barrientos A1 - Masci, Joseph R A1 - Mashal, Mohammad Taufiq A1 - Mason-Jones, Amanda J A1 - Mayosi, Bongani M A1 - Mazorodze, Tasara T A1 - Mckay, Abigail Cecilia A1 - Meaney, Peter A A1 - Mehndiratta, Man Mohan A1 - Mejia-Rodriguez, Fabiola A1 - Melaku, Yohannes Adama A1 - Memish, Ziad A A1 - Mendoza, Walter A1 - Miller, Ted R A1 - Mills, Edward J A1 - Mohammad, Karzan Abdulmuhsin A1 - Mokdad, Ali H A1 - Mola, Glen Liddell A1 - Monasta, Lorenzo A1 - Montico, Marcella A1 - Moore, Ami R A1 - Mori, Rintaro A1 - Moturi, Wilkister Nyaora A1 - Mukaigawara, Mitsuru A1 - Murthy, Kinnari S A1 - Naheed, Aliya A1 - Naidoo, Kovin S A1 - Naldi, Luigi A1 - Nangia, Vinay A1 - Narayan, K M Venkat A1 - Nash, Denis A1 - Nejjari, Chakib A1 - Nelson, Robert G A1 - Neupane, Sudan Prasad A1 - Newton, Charles R A1 - Ng, Marie A1 - Nisar, Muhammad Imran A1 - Nolte, Sandra A1 - Norheim, Ole F A1 - Nowaseb, Vincent A1 - Nyakarahuka, Luke A1 - Oh, In-Hwan A1 - Ohkubo, Takayoshi A1 - Olusanya, Bolajoko O A1 - Omer, Saad B A1 - Opio, John Nelson A1 - Orisakwe, Orish Ebere A1 - Pandian, Jeyaraj D A1 - Papachristou, Christina A1 - Caicedo, Angel J Paternina A1 - Patten, Scott B A1 - Paul, Vinod K A1 - Pavlin, Boris Igor A1 - Pearce, Neil A1 - Pereira, David M A1 - Pervaiz, Aslam A1 - Pesudovs, Konrad A1 - Petzold, Max A1 - Pourmalek, Farshad A1 - Qato, Dima A1 - Quezada, Amado D A1 - Quistberg, D Alex A1 - Rafay, Anwar A1 - Rahimi, Kazem A1 - Rahimi-Movaghar, Vafa A1 - ur Rahman, Sajjad A1 - Raju, Murugesan A1 - Rana, Saleem M A1 - Razavi, Homie A1 - Reilly, Robert Quentin A1 - Remuzzi, Giuseppe A1 - Richardus, Jan Hendrik A1 - Ronfani, Luca A1 - Roy, Nobhojit A1 - Sabin, Nsanzimana A1 - Saeedi, Mohammad Yahya A1 - Sahraian, Mohammad Ali A1 - Samonte, Genesis May J A1 - Sawhney, Monika A1 - Schneider, Ione J C A1 - Schwebel, David C A1 - Seedat, Soraya A1 - Sepanlou, Sadaf G A1 - Servan-Mori, Edson E A1 - Sheikhbahaei, Sara A1 - Shibuya, Kenji A1 - Shin, Hwashin Hyun A1 - Shiue, Ivy A1 - Shivakoti, Rupak A1 - Sigfusdottir, Inga Dora A1 - Silberberg, Donald H A1 - Silva, Andrea P A1 - Simard, Edgar P A1 - Singh, Jasvinder A A1 - Skirbekk, Vegard A1 - Sliwa, Karen A1 - Soneji, Samir A1 - Soshnikov, Sergey S A1 - Sreeramareddy, Chandrashekhar T A1 - Stathopoulou, Vasiliki Kalliopi A1 - Stroumpoulis, Konstantinos A1 - Swaminathan, Soumya A1 - Sykes, Bryan L A1 - Tabb, Karen M A1 - Talongwa, Roberto Tchio A1 - Tenkorang, Eric Yeboah A1 - Terkawi, Abdullah Sulieman A1 - Thomson, Alan J A1 - Thorne-Lyman, Andrew L A1 - Towbin, Jeffrey A A1 - Traebert, Jefferson A1 - Tran, Bach X A1 - Dimbuene, Zacharie Tsala A1 - Tsilimbaris, Miltiadis A1 - Uchendu, Uche S A1 - Ukwaja, Kingsley N A1 - Uzun, Selen Begüm A1 - Vallely, Andrew J A1 - Vasankari, Tommi J A1 - Venketasubramanian, N A1 - Violante, Francesco S A1 - Vlassov, Vasiliy Victorovich A1 - Vollset, Stein Emil A1 - Waller, Stephen A1 - Wallin, Mitchell T A1 - Wang, Linhong A1 - Wang, XiaoRong A1 - Wang, Yanping A1 - Weichenthal, Scott A1 - Weiderpass, Elisabete A1 - Weintraub, Robert G A1 - Westerman, Ronny A1 - White, Richard A A1 - Wilkinson, James D A1 - Williams, Thomas Neil A1 - Woldeyohannes, Solomon Meseret A1 - Wong, John Q A1 - Xu, Gelin A1 - Yang, Yang C A1 - Yano, Yuichiro A1 - Yentur, Gokalp Kadri A1 - Yip, Paul A1 - Yonemoto, Naohiro A1 - Yoon, Seok-Jun A1 - Younis, Mustafa A1 - Yu, Chuanhua A1 - Jin, Kim Yun A1 - El Sayed Zaki, Maysaa A1 - Zhao, Yong A1 - Zheng, Yingfeng A1 - Zhou, Maigeng A1 - Zhu, Jun A1 - Zou, Xiao Nong A1 - Lopez, Alan D A1 - Vos, Theo KW - Age Distribution KW - Epidemics KW - Female KW - Global Health KW - HIV Infections KW - Humans KW - Incidence KW - Malaria KW - Male KW - Mortality KW - Organizational Objectives KW - Sex Distribution KW - Tuberculosis AB -

BACKGROUND: The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration.

METHODS: To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets.

FINDINGS: Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990.

INTERPRETATION: Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action.

FUNDING: Bill & Melinda Gates Foundation.

VL - 384 IS - 9947 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25059949?dopt=Abstract ER - TY - JOUR T1 - Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. JF - Lancet Y1 - 2014 A1 - Kassebaum, Nicholas J A1 - Bertozzi-Villa, Amelia A1 - Coggeshall, Megan S A1 - Shackelford, Katya A A1 - Steiner, Caitlyn A1 - Heuton, Kyle R A1 - Gonzalez-Medina, Diego A1 - Barber, Ryan A1 - Huynh, Chantal A1 - Dicker, Daniel A1 - Templin, Tara A1 - Wolock, Timothy M A1 - Ozgoren, Ayse Abbasoglu A1 - Abd-Allah, Foad A1 - Abera, Semaw Ferede A1 - Abubakar, Ibrahim A1 - Achoki, Tom A1 - Adelekan, Ademola A1 - Ademi, Zanfina A1 - Adou, Arsène Kouablan A1 - Adsuar, José C A1 - Agardh, Emilie E A1 - Akena, Dickens A1 - Alasfoor, Deena A1 - Alemu, Zewdie Aderaw A1 - Alfonso-Cristancho, Rafael A1 - Alhabib, Samia A1 - Ali, Raghib A1 - Al Kahbouri, Mazin J A1 - Alla, François A1 - Allen, Peter J A1 - AlMazroa, Mohammad A A1 - Alsharif, Ubai A1 - Alvarez, Elena A1 - Alvis-Guzmán, Nelson A1 - Amankwaa, Adansi A A1 - Amare, Azmeraw T A1 - Amini, Hassan A1 - Ammar, Walid A1 - Antonio, Carl A T A1 - Anwari, Palwasha A1 - Arnlöv, Johan A1 - Arsenijevic, Valentina S Arsic A1 - Artaman, Ali A1 - Asad, Majed Masoud A1 - Asghar, Rana J A1 - Assadi, Reza A1 - Atkins, Lydia S A1 - Badawi, Alaa A1 - Balakrishnan, Kalpana A1 - Basu, Arindam A1 - Basu, Sanjay A1 - Beardsley, Justin A1 - Bedi, Neeraj A1 - Bekele, Tolesa A1 - Bell, Michelle L A1 - Bernabe, Eduardo A1 - Beyene, Tariku J A1 - Bhutta, Zulfiqar A1 - Bin Abdulhak, Aref A1 - Blore, Jed D A1 - Basara, Berrak Bora A1 - Bose, Dipan A1 - Breitborde, Nicholas A1 - Cárdenas, Rosario A1 - Castañeda-Orjuela, Carlos A A1 - Castro, Ruben Estanislao A1 - Catalá-López, Ferrán A1 - Cavlin, Alanur A1 - Chang, Jung-Chen A1 - Che, Xuan A1 - Christophi, Costas A A1 - Chugh, Sumeet S A1 - Cirillo, Massimo A1 - Colquhoun, Samantha M A1 - Cooper, Leslie Trumbull A1 - Cooper, Cyrus A1 - da Costa Leite, Iuri A1 - Dandona, Lalit A1 - Dandona, Rakhi A1 - Davis, Adrian A1 - Dayama, Anand A1 - Degenhardt, Louisa A1 - De Leo, Diego A1 - del Pozo-Cruz, Borja A1 - Deribe, Kebede A1 - Dessalegn, Muluken A1 - deVeber, Gabrielle A A1 - Dharmaratne, Samath D A1 - Dilmen, Uğur A1 - Ding, Eric L A1 - Dorrington, Rob E A1 - Driscoll, Tim R A1 - Ermakov, Sergei Petrovich A1 - Esteghamati, Alireza A1 - Faraon, Emerito Jose A A1 - Farzadfar, Farshad A1 - Felicio, Manuela Mendonca A1 - Fereshtehnejad, Seyed-Mohammad A1 - de Lima, Graça Maria Ferreira A1 - Forouzanfar, Mohammad H A1 - França, Elisabeth B A1 - Gaffikin, Lynne A1 - Gambashidze, Ketevan A1 - Gankpé, Fortuné Gbètoho A1 - Garcia, Ana C A1 - Geleijnse, Johanna M A1 - Gibney, Katherine B A1 - Giroud, Maurice A1 - Glaser, Elizabeth L A1 - Goginashvili, Ketevan A1 - Gona, Philimon A1 - González-Castell, Dinorah A1 - Goto, Atsushi A1 - Gouda, Hebe N A1 - Gugnani, Harish Chander A1 - Gupta, Rahul A1 - Gupta, Rajeev A1 - Hafezi-Nejad, Nima A1 - Hamadeh, Randah Ribhi A1 - Hammami, Mouhanad A1 - Hankey, Graeme J A1 - Harb, Hilda L A1 - Havmoeller, Rasmus A1 - Hay, Simon I A1 - Pi, Ileana B Heredia A1 - Hoek, Hans W A1 - Hosgood, H Dean A1 - Hoy, Damian G A1 - Husseini, Abdullatif A1 - Idrisov, Bulat T A1 - Innos, Kaire A1 - Inoue, Manami A1 - Jacobsen, Kathryn H A1 - Jahangir, Eiman A1 - Jee, Sun Ha A1 - Jensen, Paul N A1 - Jha, Vivekanand A1 - Jiang, Guohong A1 - Jonas, Jost B A1 - Juel, Knud A1 - Kabagambe, Edmond Kato A1 - Kan, Haidong A1 - Karam, Nadim E A1 - Karch, André A1 - Karema, Corine Kakizi A1 - Kaul, Anil A1 - Kawakami, Norito A1 - Kazanjan, Konstantin A1 - Kazi, Dhruv S A1 - Kemp, Andrew H A1 - Kengne, Andre Pascal A1 - Kereselidze, Maia A1 - Khader, Yousef Saleh A1 - Khalifa, Shams Eldin Ali Hassan A1 - Khan, Ejaz Ahmed A1 - Khang, Young-Ho A1 - Knibbs, Luke A1 - Kokubo, Yoshihiro A1 - Kosen, Soewarta A1 - Defo, Barthelemy Kuate A1 - Kulkarni, Chanda A1 - Kulkarni, Veena S A1 - Kumar, G Anil A1 - Kumar, Kaushalendra A1 - Kumar, Ravi B A1 - Kwan, Gene A1 - Lai, Taavi A1 - Lalloo, Ratilal A1 - Lam, Hilton A1 - Lansingh, Van C A1 - Larsson, Anders A1 - Lee, Jong-Tae A1 - Leigh, James A1 - Leinsalu, Mall A1 - Leung, Ricky A1 - Li, Xiaohong A1 - Li, Yichong A1 - Li, Yongmei A1 - Liang, Juan A1 - Liang, Xiaofeng A1 - Lim, Stephen S A1 - Lin, Hsien-Ho A1 - Lipshultz, Steven E A1 - Liu, Shiwei A1 - Liu, Yang A1 - Lloyd, Belinda K A1 - London, Stephanie J A1 - Lotufo, Paulo A A1 - Ma, Jixiang A1 - Ma, Stefan A1 - Machado, Vasco Manuel Pedro A1 - Mainoo, Nana Kwaku A1 - Majdan, Marek A1 - Mapoma, Christopher Chabila A1 - Marcenes, Wagner A1 - Marzan, Melvin Barrientos A1 - Mason-Jones, Amanda J A1 - Mehndiratta, Man Mohan A1 - Mejia-Rodriguez, Fabiola A1 - Memish, Ziad A A1 - Mendoza, Walter A1 - Miller, Ted R A1 - Mills, Edward J A1 - Mokdad, Ali H A1 - Mola, Glen Liddell A1 - Monasta, Lorenzo A1 - de la Cruz Monis, Jonathan A1 - Hernandez, Julio Cesar Montañez A1 - Moore, Ami R A1 - Moradi-Lakeh, Maziar A1 - Mori, Rintaro A1 - Mueller, Ulrich O A1 - Mukaigawara, Mitsuru A1 - Naheed, Aliya A1 - Naidoo, Kovin S A1 - Nand, Devina A1 - Nangia, Vinay A1 - Nash, Denis A1 - Nejjari, Chakib A1 - Nelson, Robert G A1 - Neupane, Sudan Prasad A1 - Newton, Charles R A1 - Ng, Marie A1 - Nieuwenhuijsen, Mark J A1 - Nisar, Muhammad Imran A1 - Nolte, Sandra A1 - Norheim, Ole F A1 - Nyakarahuka, Luke A1 - Oh, In-Hwan A1 - Ohkubo, Takayoshi A1 - Olusanya, Bolajoko O A1 - Omer, Saad B A1 - Opio, John Nelson A1 - Orisakwe, Orish Ebere A1 - Pandian, Jeyaraj D A1 - Papachristou, Christina A1 - Park, Jae-Hyun A1 - Caicedo, Angel J Paternina A1 - Patten, Scott B A1 - Paul, Vinod K A1 - Pavlin, Boris Igor A1 - Pearce, Neil A1 - Pereira, David M A1 - Pesudovs, Konrad A1 - Petzold, Max A1 - Poenaru, Dan A1 - Polanczyk, Guilherme V A1 - Polinder, Suzanne A1 - Pope, Dan A1 - Pourmalek, Farshad A1 - Qato, Dima A1 - Quistberg, D Alex A1 - Rafay, Anwar A1 - Rahimi, Kazem A1 - Rahimi-Movaghar, Vafa A1 - ur Rahman, Sajjad A1 - Raju, Murugesan A1 - Rana, Saleem M A1 - Refaat, Amany A1 - Ronfani, Luca A1 - Roy, Nobhojit A1 - Pimienta, Tania Georgina Sánchez A1 - Sahraian, Mohammad Ali A1 - Salomon, Joshua A A1 - Sampson, Uchechukwu A1 - Santos, Itamar S A1 - Sawhney, Monika A1 - Sayinzoga, Felix A1 - Schneider, Ione J C A1 - Schumacher, Austin A1 - Schwebel, David C A1 - Seedat, Soraya A1 - Sepanlou, Sadaf G A1 - Servan-Mori, Edson E A1 - Shakh-Nazarova, Marina A1 - Sheikhbahaei, Sara A1 - Shibuya, Kenji A1 - Shin, Hwashin Hyun A1 - Shiue, Ivy A1 - Sigfusdottir, Inga Dora A1 - Silberberg, Donald H A1 - Silva, Andrea P A1 - Singh, Jasvinder A A1 - Skirbekk, Vegard A1 - Sliwa, Karen A1 - Soshnikov, Sergey S A1 - Sposato, Luciano A A1 - Sreeramareddy, Chandrashekhar T A1 - Stroumpoulis, Konstantinos A1 - Sturua, Lela A1 - Sykes, Bryan L A1 - Tabb, Karen M A1 - Talongwa, Roberto Tchio A1 - Tan, Feng A1 - Teixeira, Carolina Maria A1 - Tenkorang, Eric Yeboah A1 - Terkawi, Abdullah Sulieman A1 - Thorne-Lyman, Andrew L A1 - Tirschwell, David L A1 - Towbin, Jeffrey A A1 - Tran, Bach X A1 - Tsilimbaris, Miltiadis A1 - Uchendu, Uche S A1 - Ukwaja, Kingsley N A1 - Undurraga, Eduardo A A1 - Uzun, Selen Begüm A1 - Vallely, Andrew J A1 - van Gool, Coen H A1 - Vasankari, Tommi J A1 - Vavilala, Monica S A1 - Venketasubramanian, N A1 - Villalpando, Salvador A1 - Violante, Francesco S A1 - Vlassov, Vasiliy Victorovich A1 - Vos, Theo A1 - Waller, Stephen A1 - Wang, Haidong A1 - Wang, Linhong A1 - Wang, XiaoRong A1 - Wang, Yanping A1 - Weichenthal, Scott A1 - Weiderpass, Elisabete A1 - Weintraub, Robert G A1 - Westerman, Ronny A1 - Wilkinson, James D A1 - Woldeyohannes, Solomon Meseret A1 - Wong, John Q A1 - Wordofa, Muluemebet Abera A1 - Xu, Gelin A1 - Yang, Yang C A1 - Yano, Yuichiro A1 - Yentur, Gokalp Kadri A1 - Yip, Paul A1 - Yonemoto, Naohiro A1 - Yoon, Seok-Jun A1 - Younis, Mustafa Z A1 - Yu, Chuanhua A1 - Jin, Kim Yun A1 - El Sayed Zaki, Maysaa A1 - Zhao, Yong A1 - Zheng, Yingfeng A1 - Zhou, Maigeng A1 - Zhu, Jun A1 - Zou, Xiao Nong A1 - Lopez, Alan D A1 - Naghavi, Mohsen A1 - Murray, Christopher J L A1 - Lozano, Rafael KW - Age Distribution KW - Cause of Death KW - Female KW - Global Health KW - HIV Infections KW - Humans KW - Maternal Mortality KW - Models, Statistical KW - Organizational Objectives KW - Pregnancy KW - Pregnancy Complications, Infectious KW - Risk Factors KW - Socioeconomic Factors KW - Time Factors AB -

BACKGROUND: The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery.

METHODS: We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values.

FINDINGS: 292,982 (95% UI 261,017-327,792) maternal deaths occurred in 2013, compared with 376,034 (343,483-407,574) in 1990. The global annual rate of change in the MMR was -0·3% (-1·1 to 0·6) from 1990 to 2003, and -2·7% (-3·9 to -1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0·4% (0·2-0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1-1262·8) in South Sudan to 2·4 (1·6-3·6) in Iceland.

INTERPRETATION: Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa.

FUNDING: Bill & Melinda Gates Foundation.

VL - 384 IS - 9947 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24797575?dopt=Abstract ER -